By Michelle Kouletio
It doesn't happen enough, but every once in a while a seed
of a sustainable health intervention is planted in the ground. In this case, the seed was planted at the
doorstep of a mayor's office in northwestern Bangladesh, amid narrow, busy
roads with open sewers of common of bustling secondary cities. Among the middle
class families live the extreme poor.
Along with several other challenges, the poor are failed by the
government health system whose facilities are overwhelmed by patient volume and
whose outreach workers do not serve. While
national policy assigned elected municipal
leaders with responsibility for ensuring coverage of equitable health
services, these leaders were provided little guidance nor resources.
With support from the USAID Child Survival and Health Grants
Program, Concern Worldwide worked in this and other municipalities in
Bangladesh to empower municipal leaders to develop a replicable model for
social mobilization in complex urban environments. What made this project
unique from so many well intended and ambitious community health projects was
the embedment of a systematic sustainability planning and monitoring system
that established a shared vision and measurement framework across the Mayor’s office,
elected representatives, service providers, social leaders and health
volunteers along with the project team.
As the technical advisor for Concern Worldwide, I had the
privilege of backstopping this initiative.
It took quite of bit of extra effort, particularly in developing
practical capacity measuring tools from scratch and maintaining regular reviews
at the neighborhood and municipality level. Sustainability planning also
required tackling structural barriers and inter-ministerial relations which
could have otherwise been ignored in a conventional project. However, the
benefits of this deeper analysis and shared accountability approach resulted in
real improvements in equitable health outcomes and an enduring political
mobilization approach that allowed the population to continue reaping benefits
years after the project closed.
Two recently published articles on this work further
validate the importance of the hard work of the Concern Worldwide staff in Bangladesh
and their contribution to the developing body of evidence on adaptive health
systems and sustainability planning: Post-script from Eric Sarriot:
These two papers coincide in their release to form a useful
series on the Concern CSHGP Bangladesh experience. The first one is part of a
larger and important Supplement of Health Research Policy and Systems on
Systems Thinking in Health, coordinated by Taghreed Adam of WHO’s Alliance for
Health Policy and Systems Research.
